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1. Field of Invention
This invention relates to mental therapy, particularly to such a therapy using a virtual reality environment. The invention will be used in medical, psychiatry, psychotherapy, education, selfhelp, home, and entertainment environments and produced with computer hardware and computer software.
2. Prior Artxe2x80x94Psychotherapy-Psychiatry-Mental Health
Originally prescriptions for mental health came from philosophers. Socrates recommended xe2x80x9cknow thyselfxe2x80x9d and this advice formed the core of psychoanalysis and psycho-dynamic treatment approaches. Though these methods permitted patients to know and understand themselves better, they failed to change thinking and behavior in a way that would cure emotional distress and impairment. Aristotle (384-323 BC) was the first person to write a systematic psychological treatise which emphasized that knowledge is gained by experience. Behavioral approaches to psychotherapy attempt to influence patient activities, but fail to explain why knowledge from that experience is not enough to correct it. Cognitive or thinking approaches to psychotherapy propose altering distortions in thinking because these lead to emotional distress. Attempts to influence conscious processes have achieved some degree of success, but patients often resist therapeutic interventions which suggest they should change their ways of thinking. Even when people are able to do so, relapses to painful thoughts and emotional distress are common.
Medical efforts to influence human behavior, mental process, and emotional distress have also relied upon invasive procedures. Trephining was a crude surgical practice of the Stone Age whereby a hole was chipped in the skull of a person who was behaving peculiarly. The procedure presumably was conducted to allow the escape of evil spirits. In the Middle Ages, bloodletting was performed for many physical and mental conditions.
Frenkel, in U.S. Pat. No. 4,327,712 (1982) describes an apparatus used to facilitate viewing of one""s facial image under controlled illumination patterns for purpose of either psychotherapy or merchandise selection. Simply allowing patients to view themselves without successfully interacting with the environment does not achieve or provide optimized corrective experience.
ECT or electroconvulsive therapy, as shown by Hyman, in U.S. Pat. No. 4,709,700 (1985), is a procedure that continues in psychiatric practice to produce an electric current through the brain to alleviate profound depression. The procedure is typically unpleasant and occasionally dangerous. Patients treated with ECT complain of memory impairment and disorientation in familiar environments.
The use of psycho-pharmacological medications dominate psychiatric practice today. Pharmacological interventions provide symptom management. Patients report some relief from emotional distress, but also complain about day-to-day life restricting side-effects of the medications. For example, psychiatric medications frequently leave patients with dry mouth, constipation, reduced or suppressed sexual interest, weight gain, bloating, sedation, benzodiazepine dependence and withdrawal, frustration with treatment failure, and dependence on the psychiatrist. Raw data from a survey of psychiatrists reveals the overall success rate with medications in the treatment of generalized anxiety disorder is less than 50%.
Woods, in U.S. Pat. No. 4,762,494 (1988) proposes using a doll-like figure on which tears can be applied or removed to reflect current or past mental states. Similar dolls are readily available in department and toy stores. Given the widespread availability of dolls with varying attributes, the possibility for a child-doll dialogue seems obvious.
An apparatus and method for treating undesirable emotional arousal of a patient is shown by Weathers in U.S. Pat. No. 5,219,322 (1993). This uses visual and auditory stimuli as a crude process for eliciting mental imagery of a negative experience. The apparatus does not correspond to natural human experience where people interact with the environment and with others. The primary goal of psychotherapy is to provide corrective experiences that can be effectively used by patients. The more closely the corrective experience simulates reality, the more effective the treatment. Weathers does not use any fully interactive visual and auditory stimulations that are under the control of the patient. He does not accurately simulate reality or permits the user to influence the environment as well as be influenced by it. His method does not closely correspond to events that occur in reality and thus, cannot be effective corrective learning contexts for patients. His method does not empower users because they are not in control of exposure to every aspect of the environmental experience.
Rodgers, in U.S. Pat. No. 5,403,263 (1995), describes a method for reducing anxiety and recovery time of a patient during preoperative, intra-operative, and postoperative phases of surgery. Unlike virtual therapy interactivity, this procedure is limited by its passive introduction of sound and voice to the patient. He does not provide much opportunity to reduce emotional distress by distraction to pleasant scenes accompanied by an auditory input. Also he does not provide opportunities for patients to recovery faster by viewing successes of others and by rehearsal of activities while immersed in a virtual environment known to facilitate recovery.
Brill, in U.S. Pat. No. 5,435,324 (1995), shows a method and apparatus for measuring psychotherapy progress. The procedure requires administration of questionnaires to patients and may be considered an assessment of the patient""s emotional state. However assessment during treatment is difficult to accomplish and requires cumbersome administration, collection, and analysis of paper and pencil tests. There is no verbal feedback during assessment and treatment, nor any description of successes and difficulties during environment encounters.
Rosenfeld, in U.S. Pat. No. 5,450,855 (1995), purports to treat alcohol and drug addiction and in U.S. Pat. No. 5,280,793 (1994) purports to treat depression by brainwave training for the purpose of achieving biofeedback. The patient is rewarded for changing asymmetry. This method of treatment shows little, if any, correspondence to known treatment practices of substance-related disorders and depression. Getting a patient to focus on brain waves de-emphasizes or eliminates the crucial variables known to cause the greatest problems for chemically dependent and depressed people. Those variables include distorted thinking, mood swings, depression, anxiety, cravings, denial, anger and rage reactions, isolation, interpersonal difficulties, family dysfunction, and need for medical detoxification, to identify but a few. He does not offers chemically dependent and depressed individuals any opportunity to achieve mastery experiences. Exposure and interactions are not under the patient""s control, any successes cannot be attributed directly to them. A lack of success does not build confidence. A lack of mental shifts from depressive thinking to optimism will not create hope or any motivation for additional successful experience.
Putnam, in U.S. Pat. No. 5,619,291 (1997), discloses an eye-movement desensitization and reprocessing treatment, but this is an awkward way to engage a patient and does not correspond to natural everyday experience. Visual displays elicit negative emotional responses. They are not interactive. There are no corrective visual sensory inputs for patient to use and experiment to achieve positive mastery experience.
3. Prior Artxe2x80x94Education and Self-Help
Dill, in U.S. Pat. No. 4,273,540 (1981), describes a training device for evaluating disorders of brain damaged patients and of patients who have suffered trauma to or disease of the central nervous system. The training attempts to help patients obtain confidence but is limited by the method. This device does not provide effective methods for assessing, preventing, and treating psychiatric conditions or for building self-efficacy. The power of a procedure is generally believed to aid in patient recovery from emotional distress. This device does not permits assessment of the patient while they are immersed in an environment, nor does it allow assessment of neurological strengths and deficits.
Ito, in U.S. Pat. No. 4,573,472 (1986), shows a medical apparatus for autogenic training. The self-help training procedure operates by providing bio-information stimuli. The user is expected to consider that information and alter behavior. This form of education and training is less effective than other self-help methods because it fails to incorporate intermediate variables known to influence human functioning. It does not provide sensory stimulations that evoke thinking distortions (fear), anticipatory anxiety, danger expectations, failure beliefs, physiological reactions (anxiety, deep breathing or holding of breadth, sweating) during exposure. The lack of composite reactions to visual exposure, auditory and tactile stimulations do not permit the practitioner to immediately introduce interventions for the purpose of achieving corrective experience. Variables that influence behavior, such as self-efficacy, cannot be assessed and strengthened during immersion of the patient in an environment. There is no development of mastery experience based upon instillation of learning principles, skill acquisition, and rehearsal.
Densky, in U.S. Pat. No. 4,717,343 (1988), shows a method for conditioning a person""s unconscious mind to effect a desired change in behavior. There is no scientific evidence for a map of the unconscious mind or how it may finction. A procedure designed to influence it cannot genuinely claim that some particular or general aspect of the unconscious mind is being influenced because the principles and processes of the unconscious are not well documented with scientific research. This self-help method exposes a person to a video picture appearing on a screen. The procedure claims that the viewer""s unconscious mind observes the video and that somehow the viewing conditions a person""s thought patterns that alter behavior in a positive way. Even if this claim were correct, the procedure is weak and does not use known learning principles and sensory stimulations to provide individuals with corrective experiences.
4. Prior Artxe2x80x94Virtual Reality Technology
The term xe2x80x9cvirtual realityxe2x80x9d has been used to describe a computer-generated environment. When viewed with goggles or head-mounted display, it provides the user with a three-dimensional, fully interactive experience. A hand-held grip is used to achieve movement or navigation within the environment. As the user turns his or her head, the view changes just as it would in reality. Buttons on the hand-held grip permit the user to experience movement from one location to another, thus adding a sense of reality, to virtual reality. The technology used to produce virtual reality consists of a graphics-generating computer, a head-mounted-display with a tracking device, a hand-held grip, and other sensory input devices. Various products may be used to achieve the experience of virtual reality (Pimentel, K. and Teixeira, K. 1993, Virtual Reality: through the new looking glass. Intel/Windcrest/McGraw-Hill, Inc. New York).
Virtual reality applications have been developed for art, business, entertainment, flight simulators, medicine, and military battlefield operations. Until 1993, medical applications included computed-aided surgery, building designs for handicapped persons, wheelchair equipped with a virtual reality system, rehabilitation, repetitive strain injury, surgical workstation, and teaching aids for surgeons.
Immersive, 3D, fully interactive virtual reality technology was first introduced as part of a psychotherapeutic method by the applicant (1993) in a Department of Psychiatry for the experimental treatment of acrophobia. The integration of virtual reality technology with learning principles and psychotherapeutic strategies was given the trademark Virtual Therapy by applicant in 1993. Virtual Therapy is a trademark for a method of treating acrophobia and other psychiatric conditions by immersion in simulated or virtual environments. Virtual Therapy provides patients with assessment of cognitive, emotional, and physiological functioning. It is also used for prevention and treatment of psychiatric conditions by providing users with corrective experiences. It is more than exposure treatment in a virtual environment and more than imaginal desensitization (Hodges et al., 1995, 1993; Rothbaum et al., 1995 (two refs.); Kooper, 1994; Williford et al., 1993).
Acrophobic individuals may experience phobic symptoms by simply thinking about heights. No exposure is required to produce anxiety, panic, or avoidance. One standard of care for this condition is cognitive-behavior therapy. Distorted thinking significantly contributes to phobic symptoms. A phobia of heights involves the interaction of thinking, behavior, and physiological arousal. Some have correctly diagnosed or evaluated the condition of acrophobia, yet proposed to treat it by exposure to a virtual environment. However, it is not the subjective evaluation that causes anxiety. There is an interaction between thinking, behavior, and physiology that contributes to anxiety. A subjective evaluation may lead to fear, which is different than anxiety. Fear is a thought. Anxiety is a physiological state. Danger expectations may produce fear whereas anxiety expectations may produce physiological arousal (anxiety). So, mere exposure to real or virtual environments is not enough to treat the condition.
A comprehensive theoretical and clinical discussion of fear, anxiety, panic, and acrophobia can be found in Virtual Therapy (Lamson, 1997). Prior studies exposed participants to virtual environments where the opportunity to perceive height and depth occurred. However, the method of treatment was not adequately explained and there was no theoretical or clinical rationale for exposure therapy. It differs from Virtual Therapy (Lamson, 1997) which describes a system of therapy for the treatment of acrophobia and other psychiatric conditions.
Carlin et al. (1997) present a case report to demonstrate the use of immersive computer generated virtual reality (vr) and mixed reality (touching real objects seen in virtual reality) for the treatment of spider phobia. A patient was exposed to virtual spider scenes over 12 weeks with each session lasting a total of 50 minutes. Exposure to virtual reality spiders produced reduction in anxiety with some symptom relief. The case is difficult to assess because of apparent co-existing obsessive-compulsive difficulties. The authors define their intervention as virtual reality exposure therapy. However, no theoretical rationale for conducting 12 treatment sessions with the patient was discussed.
North et al. (1997) reports on a five-session, single-case study, utilizing virtual reality as a desensitization procedure to reduce fear of flying. The authors"" three paragraph letter-to the editor failed to cite any research protocol, method of desensitization, or psychological rationale.
A virtual environment trademarked xe2x80x9cDetourxe2x80x9d (Addison, 1994) was constructed for the purpose of demonstrating the perceptual experience of one person who suffered brain damage from an auto accident. The application was developed for use in the CAVE, a trademark for an immersive room size virtual reality environment located at the University of Chicago. This particular application evokes deep empathy by visual and auditory sensory inputs. The virtual environment presents scenes of art and the impression of walking down a corridor viewing paintings hung on walls. Suddenly wheels screech and a crash and moan are heard. The scene becomes distorted and unclear, signifying the loss of vision and brain damage. Addison actually suffered brain injury. Though the virtual environment was created to dramatize her traumatic experience, it suggests avenues for other uses.
Gould, in U.S. Pat. No. 5,546,943 (1996) proposes use of a visualization system using a computer to provide a patient with a view of their internal anatomy based on medical scan data. The patient acts upon the information in an interactive virtual reality environment by using tools or other devices to diminish a visual representation of an ailment. In doing so, a psychoneuro-immunological response is postulated to occur in the patient for combating and recovering from the disease. The concept is interesting, yet the activation of a psychoneuroimmunological response may be due to any process that builds an individual""s self-efficacy. Self-efficacy is a well known psychological variable proposed to account for an individual""s conviction that they can achieve or accomplish or perform a certain task.
Jarvik, in U.S. Pat. No. 5,577,981 (1996) describes a virtual reality exercise machine and computer controlled video system. Jarvik""s machine produces a virtual reality environment for exercise regimens, exercise games, competitive sports, and team sports. It is also adapted to a user""s individual capabilities. It is used to achieve exercise results from rehearsal.
Walker, Lyon, Linton, and Nye, in U.S. Pat. No. 5,584,696 (1996) describe a simulation system for virtual reality experiences such as hang gliding or the like. They describe an embodiment for mechanical support, visual display, and a method for achieving pupil-forming images.
Kitchen and Bird, in U.S. Pat. No. 5,655,909 (1995) describe a skydiving trainer wind tunnel utilizing a non-immersive virtual reality environment produced by viewing film footage of scenarios descending toward the earth. They provide the user with an opportunity to practice emergency procedures. It does not use an head-mounted display for immersion into the virtual environment.
These devices do not use virtual environments for assessment, prevention, and treatment of psychiatric conditions and for conditions not described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 1994). They do not rely upon the integration of learning principles and psychotherapeutic strategies with any virtual reality technology. They do not use visual, auditory, and tactile sensory stimulation and feedback during user immersion in virtual environments to assist patients in achieving corrective experiences. The lack of instillation of explicit learning principles during virtual environment exposure prevents users from the direct influence of psychological, emotional, and physiological processes for the development of mental health.
The following are the full citations of references given in abbreviated form in the text:
Addison, R. (1995). Detour: brain deconstruction ahead. In: Satava, R. M., Morgan, K., Sieburg, H. B., Mattheus, R., and Christensen, J. P. Interactive technology and the new paradigm for healthcare. Pp. 1-3. IOS Press, Amsterdam, Oxford, Washington, D.C.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders: Fourth Edition. DSM-IV. Washington, D.C.
Carlin, A. S., Hoffinan, H. G., and Weghorst, S. (1997). Virtual reality and tactile augmentation in the treatment of spider phobia: a case report. Behavior Research Therapy, 35(2): 153-58.
Hodges, L. F., Rothbaum, B. O., Kooper, R., Opdyke, D., Meyer, T., North, M., de Graaff, J. J., and Williford, J. (1995). Virtual environment for treating the fear of heights. IEEE Computer 28, 7, pp. 27-34.
Kooper, R. (1994). Virtually present: treatment of acrophobia by using virtual reality graded exposure. Master Thesis in Computer Science at the Technical University of Delft, Netherlands.
Lamson, R. (1989). The effects of a manual-guided cognitive intervention program upon substance abusers. Unpublished dissertation. University of Southern California.
Lamson, R. (1993). The effects of virtual reality immersion on anxiety disorders. Kaiser Foundation Research Institute.
Lamson, R. (1994). Virtual therapy of anxiety disorders: application: VR in psychotherapy. CyberEdge Journal, Issue #20, Vol. 4, No. 2. Sausalito, Calif.
Lamson, R. and Meisner, M. (1994). The effects of virtual reality immersion in the treatment of anxiety, panic, and phobia of heights. Proceedings for Virtual Reality and Persons with
Disabilities, pp. 63-68. Second Annual International Conference, Center on Disabilities, California State University, Northridge.
Lamson, R . and Meisner, M . (1995). Clinic al app lication of virtual therapy to psychiatric disorders: theory research, practice. Pre-Conference Workshop, Medicine Meets Virtual Reality #4.
Lamson, R. (1997). Virtual Therapy: prevention and treatment of psychiatric conditions in virtual reality environments. Polytechnic International Press. Montreal Canada. ISBN 2-553-00631-4.
Maier, S. F., Watkins, L. R., and Fleshner, M. (1994). Psychoneuroimmunology: the interface between brain, behavior, and immunity. American Psychologist, 49(12): 1004-17.
Manning, T. R. (1995). The emotional dimension of experience in information environments. In: Satava, R. M., Morgan, K. , Sieburg, H. B., Mattheus, R., and Christensen, J. P. Interactive technology and the new paradigm for healthcare. Pp. 231-236. IOS Press, Amsterdam, Oxford, Washington, D.C.
North, M. M, North, S. M., and Coble, J. R. (1997). Virtual reality therapy for fear of flying. Letter to the editor, American Journal of Psychiatry, 154:1, p. 130.
Pimentel, K. and Teixeira, K. (993). Virtual Reality: through the new looking glass. Intel/Windcrest/McGraw-Hill, Inc. New York.
Rothbaum, B. O., Hodges, L. F., Kooper, R., Opdyke, D., Williford, J., and North, M. (1995a). Virtual reality graded exposure in the treatment of acrophobia: a case study. Behavior Therapy, Vol. 26, No. 3, pp. 547-554.
Rothbaum, B. O., Hodges, L. F., Kooper, R., Opdyke, D., Williford, J., and North, M. (1995b). Effectiveness of computer-generated (virtual Reality) graded exposure in the treatment of acrophobia. American Journal of Psychiatry, Vol. 152, No. 4, pp. 626-628.
Williford, J. S., Hodges, L. F., North, M. M, North, S. (1993). Relative effectiveness of virtual environment desensitization and imaginal desensitization in the treatment of acrophobia. Proceedings Graphics Interface, 162, Toronto.
Objects and Advantages
Accordingly, it is one object of the invention to provide a method for treating psychiatric conditions by immersion into virtual reality environments for the purpose of providing corrective experiences.
The term Virtual Therapy was introduced by Lamson (1993) and is used to define a process that occurs when patients are visually immersed in a virtual environment. Since the environment is fully interactive, users engage in activity for the purpose of providing corrective experience to cognitive distortions, emotional distress, and behavioral deficits. Auditory and tactile sensory inputs may be included to enhance a user""s sense of reality during immersion. In the case of phobias, psychological distress is maintained by beliefs, appraisal of threat, anxiety, and situational avoidance. Healing occurs when users develop thinking strategies that result in reduction of distress, increased confidence, and approach behavior.
Exposure to Virtual Therapy environments is under the control of the user. During exposure, users encounter situations through visual, auditory, and tactile sensory stimulation. They may influence or be influenced by that environment. Virtual Therapy is a rapid, non-invasive form of immersive, three-dimensional, interactive treatment. Whether used as a therapeutic method by a licensed therapist, mode of education, self-help, or entertainment process, it presents a less-costly alternative to other forms of treatment currently used in psychiatry.
In addition to the above objects and advantages, several additional objects and advantages invention are described in the following factors 1.a to 1.p. and 2.a-2.m below.
1.a. Immersion into a Virtual Therapy environment permits rapid assessment, prevention, and treatment of psychiatric conditions.
1.b. The method of Virtual Therapy combines therapeutic strategies with learning principles to achieve corrective experiences.
1.c. Virtual Therapy combines methods of education and self-help with entertainment in virtual environments to enhance learning.
1.d. Exposure to visual, auditory, and tactile sensory inputs in the virtual environment are under the control of the user or patient.
1.e. Rapid habituation learning evidenced by rate and blood pressure reductions during virtual environment immersion and exposure.
1.f Virtual Therapy is a faster, better, cheaper method of psychotherapy than other existing methods. Treatment of acrophobia shows that patients benefit from one 50-minute session. Avoidance and anxiety are diminished or eliminated to the extent that patients are able to ascend to heights.
1.g. Compared to other known forms of treatment, Virtual Therapy shows approximately 50% savings.
1.h. Virtual Therapy is simpler than other methods of treatment. Direct sensory input and interactivity permit patients to immediately gain skill and relief from painful symptoms.
1.i. The technology of Virtual Therapy can be easily placed in shopping malls, community centers, schools, hospitals, and offices used for therapeutic interventions.
1.j. The method of Virtual Therapy de-emphasizes the notion of pathology known to psychodynamic forms of treatment. Instead, the method emphasizes learning, self-efficacy, mastery experience, and competence in virtual environments. The entertaining and educational components of Virtual Therapy make public access in shopping malls ideal locations for this form of treatment.
1.k. The technology is safe and easy to use. It produces reliable virtual environments with a lasting life cycle.
1.l. Virtual therapy satisfies several existing needs: cost effectiveness and prevention and treatment of alcohol and drug abuse; also it is entertaining, educational, and exciting.
1.m. Hundreds of telephone calls and letters from the United States and foreign countries have been received after news broadcasts concerning Virtual Therapy research. Many of those inquiring about the treatment offer to pay, regardless of cost.
1.n. Virtual Therapy may be combined with newly available wireless technologies. One example of wireless technology is a telephone with an eyepiece that permits a view of the person being called.
1.o. Though virtual reality technology has been used for visualization in flight simulators, games and entertainment, it is newly described here as a complete system of psychotherapy having medical and self-help ramifications.
1.p. The use of Virtual Therapy produced new and unexpected results and in doing so, suggests it may be used for commercial success. It also satisfies a long-felt but unsolved need to provide psychological services faster, better, cheaper and without the stigma of pathology attached to psychiatry departments.
Virtual Therapy is related to cognitive psychology, behavioral therapy, and behavioral neuroscience. The therapy actively involves the patients"" visual system. It is structured, time-limited, and has been successfully used in the treatment of specific phobias of the natural environment type, such as acrophobia. Generalization of treatment effects have been reported for conditions coexisting with acrophobia. For example, a substantial number of patients undergoing Virtual Therapy report past psychological trauma related to physical and emotional abuse, abandonment, and terror from living under a dictatorship. Post-treatment evaluation indicate reduced sense of treat from longstanding emotional disabilities. The therapy is based on clinical trials that show that virtual reality can be used to create experiences that influence how people feel, think, and act. When an acrophobic enters a virtual environment by visual immersion using a head mounted display (helmet), he or she immediately interact with the environment.
Patients receive proprioceptive-response feedback from turning the head to scan, for example, a computer-generated room with textured walls and muted lighting. Participants receive more feedback when they press a button on a hand-held grip in order to move in the virtual world, achieving gradual exposure to heights and depths by clicking or continuously pressing the button. To change the direction of movement, the user simply turns his or her head to the desired view and presses a button. Reduction of exposure to aversive stimuli occurs by looking away, moving to a new location in the virtual environment, using distraction techniques, talking or using other sensory input to re-establish contact with reality, or taking off the helmet.
A sense of danger during virtual reality immersion is derived from encounters that elicit fear. An encounter initially increases production of fearful cognitive processing for most people. Acrophobics may dwell on beliefs that emerge and flood their consciousness, such as xe2x80x9cI""m not capable. I can""t handle it. I""ll never be able to get over my fears.xe2x80x9d These beliefs are enduring for this person. One valuable component of Virtual Therapy is the opportunity to observe, challenge, and change dysfunctional beliefs.
The events that occur during immersion into a computer-generated environment stimulate memory. Some pertain to undesirable experiences. A sense of threat could unfold from memory, exposure, or both. These occur in the same context that also promotes healing. Exposure to phobic stimuli is known to provoke situational-bound anxiety or panic. The rapid onset of distress appears spontaneous. Therapeutic interventions provided at these critical moments can alter patient dysphoria: xe2x80x9cBreathe deeply. Stay there long enough to realize you are okay. Look around. You did this successfully a few minutes ago. You can do it again. You are safe. You are capable. You""re doing it.xe2x80x9d Patients achieve mastery experiences in this way, and their confidence grows.
Virtual Therapy gives the user an opportunity to experiment with thinking. Instead of dreading a fall from a virtual bridge perceived to be elevated hundreds of feet above water, the user may pause long enough to become familiar with safety. Safety is achieved by scanning the virtual environment. The patient first considers a location, then scouts out potential directions of travel. Thoughts, feelings, heart rate, and muscle tension are observed during the excursion. Threat and caution give way to experimentation. Moving closer to the side of the bridge and looking over may initially provoke feelings of threat. Yet, within a very short period of time, minutes, the user begins to experience habituation. Tension drains from the patient""s physiology (e.g. neck and shoulders) and deep breaths produce a relaxed posture.
Additional Objects And Advantages
2.a. Previous failure of others. Virtual Therapy is a form of treatment that provides exposure under the control of the patient. Previous exposure methods brought the patient into contact with reality in the presence of a clinical practitioner. Flooding is an example of this kind of exposure. Unfortunately, flooding was a crude attempt at desensitizing patients to their fears and phobias that showed varied success. Some patients became more sensitized, more anxious, and more phobic after flooding treatment than before.
2.b. Solves an unrecognized problem. Standard forms of psychotherapy utilize face-to-face visits with a clinician (therapist), group therapy, psycho-educational workshops (classes), and medications (which is an invasive procedure). Virtual Therapy does involve a therapist. But the treatment takes place in a virtual environment where the patient has the opportunity to face challenges and struggles by visual and auditory immersion. Virtual encounters permit the patient to rapidly confront and resolve problems resulting in anxiety, panic, phobias, depression, and chemical dependency.
2.c. Solves an insoluble problem. Transference is a psychological phenomena described in the literature. It is understood to be a relationship problem that evolved from the patient""s past experiences but was transferred on to the therapist. It occurs between the patient and therapist. In Virtual Therapy, the patient interacts with the technology and virtual environment. The patient influences the environment and is influenced by it. Thus, transference to the therapist is eliminated because the patient""s focus is absorbed by interactions with the virtual environment.
2.d. Commercial success. Virtual Therapy has NOT been offered commercially. However, the success of virtual therapy treatments has received media attention. Therefore, hundreds of calls from across the United States and around the world have been received, requesting treatment. Blue Shield of California is providing alternative health care such as acupuncture, chiropractic and other alternative health care services at discount prices to its 1.6 million California members. In January, 1998, the Blue Shield alternative health care program, called Lifepath, will offer access to a network of more than 1,000 qualified practitioners including massage therapists, stress management experts, and fitness clubs. xe2x80x9cConsumers don""t always want invasive procedures and Blue Shield is responding to their desire for more choicesxe2x80x9d said Myra Snyder, president of the California Association of Health Plans. The potential market for Virtual Therapy includes traditional health care subscribers and out-of-pocket payers for alternative care. Blue Shield estimates that consumers spend approximately $10 billion annually (out-of-pocket) on alternative health care services.
Virtual Therapy is a non-invasive procedure. It is currently used experimentally and suitable for other traditional and alternative health care environments as suggested by the Blue Shield Lifepath program.
2.e. Unappreciated advantage. Virtual Therapy is a new form of treatment that occurs when the patient interacts with a 3D computer generated immersive virtual environment which contains varied objects, images, colors, and sounds. A hand-held grip with buttons allows the patient to move forward with a sensation of walking of flying. It will also permit vertical upward or downward movement. The patient can change the environment by moving, adding, removing, enlarging, subtracting, and multiplying the number of objects present. For example, the patient may choose to pick up a chair and move it to another side of the room; turn on a fan; turn the room lights on or off; open a door; add a lamp to a table; drop an object that sounds as if it is breaking. and so on. Collectively, these movements provide therapeutic advantages over other forms of treatment because the patient, then and there, can rehearse and practice tasks previously consider overwhelming, in a safe virtual environment.
2.f. For millennia, healers, shamans, priests, and physicians attempted to call upon xe2x80x9chigher powersxe2x80x9d and spirits to cure the patient. Visions were reported by those afflicted with emotional distress (William James, Varieties of Religious Experience) Now, in Virtual Therapy, visual and auditory sensory inputs generate images and sounds to influence the patient. The virtual experience captures the imagination of the patient and can be used effectively to heal them.
2.g. Solution of long-felt need. Virtual Therapy solves a long-felt need to clarify the therapeutic process. Compared to other systems of psychotherapy, the process is well defined and can be replicated anywhere to validate treatment results. The personality of the therapist is less important with this form of treatment than others because the patient interacts with the technology to receive corrective experiences. It eliminates arguments about the nature of the cure because it is less the therapist and more the quality of the virtual environment interaction that leads to patient health.
2.h. Contrary to prior art""s tea ching. Virtual Therapy contradicts previous notion s that the therapist is all important in therapeutic endeavors because healing was presumed to take place through a transference process. It challenges prescriptions for therapy with someone specialized in psychodynamic, cognitive, behavioral, existential, gestalt or other mode or medium. Virtual Therapy eliminates such conceptualizations and arguments with the use of re-usabl e virtual environments for healing. The virtual contexts are integrated with learning principles for providing each patient with a corrective learning experience.
2.i. Virtual Therapy integrates virtual reality technology with known psychological principles derived from cognitive-behavioral therapies, existentialism, psychodynamic conceptualizations and knowledge based upon behavioral neuroscience, neurobiology and neurophysiology. The resultant form of treatment, virtual therapy, yields results far in excess of the principles specific to each contributing component. The synergistic effect was not anticipated by original pioneers in the fields of computer science and engineering who experimented with virtual reality. (Pimentel K. and Teixeira, K. (1993) Virtual Reality. Inte/Windcrest/McGraw-Hill, Inc., New Y ork).
2.j. Different combination. Virtual Therapy combines technology with learning principles to provide corrective experiences for patients diagnosed with psychiatric and medical difficulties. It may also be used for those not formerly diagnosed yet experiencing difficulties with daily living. The benefits of this form of treatment are documented (Lamson, R., 1997. Virtual Therapy, supra). Virtual Therapy currently utilizes 3D immersion technology, including a head mounted display. As technological innovations advance with the concurrent building of learning principles into virtual environments (for therapeutic change), the delivery of this information through visual sensory input may take varied forms. For example, the visual display may be attached to a phone so that remote access to virtual environments may occur at home, in the office, or in public areas. Cellular technology, combined with a visual display, increases the opportunity to influences conscious processes at remote sites. Virtual Therapy may use video in two dimensions or video in three-dimension immersion using a head-mounted display.
2.k. Prior-art references would not operate in combination. The prior-art of virtual reality, identifying computer technology, graphic displays, hand-held-grip, and graphics (e.g. military applications, flight simulation, NASA COSTAR Mission to repair the hubble telescope) was not enough to suggest application of the individual or collective components for psychiatric treatments.
2.l. The Virtual Therapy method demonstrates that it is an inventive combination of prior art. These include but are not limited to computer technologies that produce graphics (SGI Machines, Division ProVision 100, Pixel Plane Technology), head-mounted displays (Virtual Research Flight Helmut, Division, Eyegen 3, Stereo Graphics Crystal Eyes), hand-held grips (Division Joystick and Logiteck 3D), and software support (Division, DVS) to produce stereo image generation, binaural audio synthesis, collision detection, and integration of a range of peripheral devices such as gloves and head-mounted display systems. Authoring software (Division, dVISE) can be used by non-programmers to import objects for the purpose of building and modifying virtual environments. In addition, knowledge of assessment and treatment of psychiatric conditions from varied psychological perspectives and theoretical backgrounds serves as xe2x80x9cpsychological softwarexe2x80x9d for the production of virtual environments. Knowledge of vision and the development and influence of perception using psychological principles is findamental to this form of treatment.
Further objects and advantages of my invention will become apparent from consideration of the drawings and ensuing description.
Virtual therapy differs from the prior art by using virtual environments for assessment, prevention, and treatment of psychiatric conditions and for conditions not described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 1994). Visual, auditory, and tactile sensory stimulation and feedback during user immersion in virtual environments are used to assist patients in achieving corrective experiences. The instillation of explicit learning principles during virtual environment exposure permit users to directly influence psychological, emotional, and physiological processes for the development of mental health.
Virtual therapy is primarily a psychotherapeutic, psychiatric, medical, educational, and self-help invention for prevention and treatment of psychiatric disorders and for problems not otherwise specified in psychological assessment and diagnostic literature. The process is comprehensive and takes place during immersion in fully interactive three-dimensional virtual reality environments utilizing computer generated graphics, images imported from photographs, and video for sensory stimulation. Immersion is achieved with goggles, a head-mounted-display, or another form of visual stimulation, such as surround projection screens or monitors or devices that permit the user to have a virtual experience. It includes the use of voice, music, and sound and other forms of physiological stimulation and feedback. Body sensors and devices such as a hand-held grip, permit the user to interact with objects and navigate within the virtual environment.
Virtual therapy is psychotherapeutic because it permits assessment, diagnosis, and treatment of cognitive, emotional, and behavioral functioning of the user during immersion in the virtual environment. Virtual therapy is also an educational intervention because principles of learning are built into the method so that the user achieves maximum benefit from the experience. Sensory stimulation is known to influence habituation and sensitization (forms of learning associated with neurons) along the visual pathway. Visual sensory input during immersion in the virtual environment shows promise for assessing and treating medical conditions related to vision, migraine headaches, pain, strokes and other neurological states influenced by learning and memory. Virtual therapy provides opportunities for self-help when the user of a virtual environment is provided with information on how to benefit from the experience or when a provider gives verbal directions on how to benefit from the experience or when the virtual environment itself provides the user with directions on effective use of learning strategies during immersion in the virtual environment.
Virtual therapy is an evolving system of psychotherapy conceptualized before and after clinical trials (Lamson, 1993) (full citations of all references are listed above) using virtual reality immersion technology. It utilizes descriptions of psychiatric disorders from Diagnostic and Statistical Manual of Mental Disorders IV (APA, 1994). It also derives the etiology of disorders from research literature and clinical interviews. It provides therapeutic principles and techniques unique to interventions aimed at reduction of distress, found, e.g., in anxiety, panic, phobias, depression, alcohol and drug abuse/dependence, and somatization conducted in virtual environments.
Virtual therapy includes the assessment of cognitive, emotional, and physiological functioning before, during, and after treatment of psychiatric conditions. Some of the conditions referred include obsessive-compulsive disorder, phobias, depression, panic disorder, migraine headaches co-existing with other psychiatric disorders and others. As a natural extension of treatment and referrals from other practitioners, virtual therapy has conceptualized evaluation and possible treatment of individuals suffering neurological impairments resulting from stroke and brain trauma.